OBJECTIVES: The aim of this research is to assess US Medicare methodologies for the reimbursement of medical devices in hospital inpatient and outpatient services. METHODS: A comprehensive literature search was conducted on PuBmed and US Department of Health and Human Services specific to Centers for Medicare and Medicaid Services (CMS). RESULTS: CMS reimbursement structure is shaped by coverage, coding and payment arrangements with reimbursement playing a major role for commercially available devices and coding and coverage for devices under clinical studies. The payment mechanisms applied are defined by diagnosis related groups (DRG; hospital inpatient) and ambulatory payment classification (APC; hospital outpatient) with an additional three separate short-term payment policies: new technology add on payments for in-patient services, transitional pass-through payments and new technology ambulatory payment classifications for outpatient services. Biannual reports are performed on existing and new policies for both inpatient and outpatient provisions with updates on the reimbursement system retrospectively from 2-3 years prior to year of implementation. A case example in cardiac resynchronization therapies (CRT) in both inpatient and outpatient setting is used to illustrate the reimbursement mechanisms used by US Medicare. Medicare used a new technology add-on payment for 1 year (up to $16,262 supplemental funding) in addition to DRG payment (ranging from $81,950 to $104,092). To compare volume and estimated payments of CRT devices in the outpatient setting (2,358 outpatient compared to 21,920 inpatient) a separation of APC codes (with intent to create a new APC code) was conducted. The creation of a new APC code was refused with further restructuring of existing codes. CONCLUSIONS: The results show regular and systematic collection of data to revise tariffs each year act as the main feature to allow for new medical technology to be accessible.